Victims may have tears in the vagina, cuts and bruises, upsetting emotions, and difficulty sleeping.

Sexual transmitted diseases, including infection with the HIV (human immunodeficiency virus), and pregnancy are risks.

Women or men who are raped should be thoroughly evaluated in a center staffed by specially trained people (rape center).

Treatment of physical injuries, antibiotics to prevent infections, emergency contraception, and counseling or psychotherapy are often needed.

If possible, family members and close friends should meet with a member of the rape crisis team to discuss how to support a rape victim.

Rape is typically considered to be unwanted penetration of the victim’s vagina, anus, or mouth. In victims younger than the age of consent, penetration of the vagina, anus, or mouth—whether wanted or not—is considered rape (statutory rape).

Sexual assault is a broader term, including the use of force and threats to coerce any sexual contact and unwanted touching, grabbing, or kissing.

The reported percentage of women who have been raped during their lifetime varies widely: from 2% to almost 30%. The reported percentage of children who are sexually abused is similarly high (see Sexual abuse). Reported percentages are probably lower than the actual percentages because rape and sexual abuse are less likely to be reported to the police than are other crimes.

Typically, rape is an expression of aggression, anger, or the need for power and control rather than sexually motivated. Many women who are raped are also physically beaten and/or injured.

Men are also raped. Men are more likely than women to be physically injured and less likely to report the rape.

Symptoms

Symptoms and complications can include

Physical injuries

Psychologic effects

Sexually transmitted diseases

Pregnancy

Physical injuries resulting from a rape may include tears in the upper part of the vagina and injuries to other parts of the body, such as bruises, black eyes, cuts, and scratches.

The psychologic effects of a rape are often more devastating than the physical. Shortly after a rape occurs, almost all victims have symptoms of posttraumatic stress disorder (PTSD), which can occur after any stressful event (see Posttraumatic Stress Disorder (PTSD)). They feel fearful, anxious, and irritable. They may feel angry, depressed, embarrassed, ashamed, or guilty (wondering whether they may have done something to provoke the rape or could have done something to avoid it). They may have intrusive, upsetting thoughts or mental images of the assault, and they may relive the rape through flashbacks. Or they may stifle thoughts and feelings about the rape. They may avoid situations that remind them of the rape. Difficulty sleeping and nightmares are common. These symptoms may last for months, interfering with social activities and work. However, for most victims, symptoms lessen substantially over a period of months.

Many victims have both PTSD and depression.

After a rape, there is a risk of infection with sexually transmitted diseases (such as gonorrhea, chlamydial infection, and syphilis) and hepatitis B and C. Infection with the human immunodeficiency virus (HIV) is a particular concern, even though the chances of acquiring it in a single encounter are low. A woman may also become pregnant.

Evaluation

A physical examination

If the victim consents, tests to collect evidence and check for sexually transmitted diseases

A pregnancy test

Having a thorough medical evaluation after a rape is important. Whenever possible, women who have been raped or sexually assaulted are taken to a sexual assault center that is staffed by trained, concerned support personnel. The center may be a hospital emergency department or a separate facility. Although men who have been raped should also seek medical attention. However, there are fewer centers staffed by personnel specifically trained to examine men who have been raped,

After a rape, the victim decides whether to consent to actions that will allow eventual prosecution. Advantages and disadvantages proceeding should be explained. The victim should feel no pressure to consent, although consent is generally in the victim's best interest.

If the victim chooses to proceed, doctors are required by law to notify the police and to examine the victim. The examination can provide evidence for prosecution of the rapist. The best evidence is obtained when the rape victim goes to the hospital as soon as possible, without showering or washing, without brushing the teeth, without changing clothes, and, if possible, without even urinating. The medical record resulting from this examination is sometimes used as evidence in court proceedings. However, the medical record cannot be released unless the victim gives her consent in writing or a subpoena is issued. The record may also help the victim recall details of the rape if the victim's testimony is required later.

Immediately after a rape, a woman may be hesitant or afraid of undergoing a physical examination. If possible, a female doctor examines the woman. If not, a female nurse or volunteer is present to help allay any anxiety the woman may be feeling. Before beginning the examination, the doctor explains what will be done during the examination and asks the woman for permission to proceed. The woman should feel free to ask any questions about the examination and its purpose.

The doctor asks the woman to describe the events to help guide the examination and treatment. However, talking about the rape is often frightening and distressing for the woman. She may request to give a complete description later, after her immediate needs have been met. She may first need to be treated for injuries and to have some time for calming down.

To help determine the likelihood of pregnancy, the doctor asks the woman when her last menstrual period was and whether she uses a contraceptive. To help interpret the analysis of any sperm samples, the doctor asks the woman if she recently had sex before the rape and, if so, when.

The doctor notes physical injuries, such as cuts and scrapes, and may examine the vagina for injuries. Photographs of injuries are taken. Because some injuries such as bruises become apparent later, a second set of photographs may be taken later. A swab is used to take samples of semen and other body fluids for evidence. Other samples, such as samples of the perpetrator’s hair, blood, or skin (sometimes found under the woman’s nails), are collected. Sometimes DNA testing of the samples is done to identify the perpetrator. Some of the woman’s clothing may be kept for evidence.

If the woman consents, blood tests are done to check for infections, including HIV infection. If the initial test results for gonorrhea, chlamydial infection, syphilis, and hepatitis are negative, the woman is tested again at 6 weeks. If results for syphilis and hepatitis are still negative, tests are repeated at 6 months. Blood tests for HIV infection may be repeated after 90 and 180 days. A Papanicalaou (Pap) test is done to check for human papillomavirus infection after 6 weeks.

Usually, a pregnancy test to measure the level of human chorionic gonadotropin in the urine (see Detecting and Dating a Pregnancy) is done during the initial examination to detect any preexisting pregnancy. If the results are negative, the test is repeated within 6 weeks to check for pregnancy that may have resulted from the rape.

Treatment

Treatment of any physical injuries

Drugs and sometimes vaccines to prevent infections, including HIV infection

Emergency contraception if the woman wants it

Psychologic support or intervention

After the examination, the woman is offered facilities to wash, change clothing, use mouthwash, and urinate if needed.

Any physical injuries are treated.

Preventing infections

For preventing infections, the woman is given antibiotics. For example, she may be given one dose of ceftriaxone injected into a muscle, one dose of metronidazole given by mouth, and either doxycycline given by mouth for 7 days or azithromycin given by mouth once.

If the woman has not been vaccinated against hepatitis B, she is given the vaccine, followed by two more doses, one 1 month and one 6 months after the first dose.

If test results for HIV are positive, the woman probably had HIV infection before the rape because HIV infection acquired through sexual intercourse typically cannot be detected until 9 days to 6 months later. If test results for HIV are positive, treatment for HIV is started immediately (see Human Immunodeficiency Virus (HIV) Infection : Treatment). If test results are negative, the HIV test is repeated several times over the next several months.

Regardless of test results, treatment to prevent HIV infection may be offered to the woman. On average, the chance of developing HIV infection after rape from an unknown assailant is low—only about 0.2%. Risk may be higher if any of the following occurred:

Anal penetration

Bleeding (from the assailant or victim)

Male-male rape

Rape by several assailants (as may happen to men in prison)

Rape that occurs in areas where HIV infection is unusually common

Treatment to prevent HIV infection is most effective if started within 4 hours after penetration and should not be given if more than 72 hours have passed since penetration.

Preventing pregnancy

If the woman is not already pregnant, emergency contraception is provided if the woman wants it. Usually, it consists of a high dose of an oral contraceptive given immediately, then repeated 12 hours later (see Emergency Contraception). This treatment is 99% effective if given within 72 hours of the rape.

Inserting an intrauterine device (IUD) within 10 days of the rape is even more effective.

If pregnancy results from the rape, abortion can be considered.

Providing psychologic support

Doctors explain the psychologic reactions that commonly occur after the rape (such as excessive anxiety or fear or guilt) to the victim. This information can help victims accept and deal with their reactions.

As soon as feasible, a person trained in rape crisis intervention meets with the victim. Victims are referred to a rape crisis team if one is located in the area. This team can provide helpful medical, psychologic, and legal support. For victims, talking about the rape and their feelings about it can help them recover.

If victims continue to have symptoms of posttraumatic stress disorder (such as flashbacks, disrupted sleep, or fear that interferes with doing normal activities), psychotherapy and/or antidepressants can be effective (see Posttraumatic Stress Disorder (PTSD): Treatment). Victims may be referred to a psychologist, social worker, or psychiatrist.

Family members and friends may have some of the same feelings as the victim: anxiety, anger, or guilt. They may irrationally blame the victim. Thus, in addition to their own feelings, rape victims may have to handle negative, sometimes judgmental or derisive reactions of family members and friends, as well as those of officials. These reactions can interfere with recovery. Family members or close friends may benefit from meeting with a member of the rape crisis team or sexual assault evaluation unit to discuss their feelings and how they can help the victim. Usually, listening supportively to the victim and not expressing strong feelings about the rape are most helpful. Blaming or criticizing the victim may interfere with recovery.

A support network of health care practitioners, friends, and family members can be very helpful to the victim.

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